02-06-06
State Legislative Forecast
Charles Willmarth
Several state associations plan to open their state practice acts or begin licensure initiatives this year. Many will be monitoring efforts of other professions to expand their scope of practice or to limit the scope of occupational therapy practice.
Licensure initiatives are underway in Michigan and Indiana. Licensure is the highest form of regulation of a profession and clearly articulates the profession's scope of practice to consumers, payers, government officials, and other health professions. AOTA encourages state associations to pursue legislation to periodically update scope of practice language in their state licensure laws. The Michigan Occupational Therapy Association has secured a sponsor for its licensure bill. The Indiana licensure bill (S.B. 130) was recently introduced to the Senate Health and Provider Services Committee. Legislation in both states uses AOTA's definition of occupational therapy practice. The Indiana Occupational Therapy Association has created a page on its Web site (http://www.inota.com) that allows practitioners to write support letters to their state legislators. AOTA will support both initiatives by providing technical assistance and grassroots communications. Members in Indiana and Michigan are encouraged to contact their legislators in support of licensure.
In collaboration with the North Carolina Board of Occupational Therapy, the North Carolina Occupational Therapy Association (NCOTA) will again pursue legislation (H.B. 287) this session to revise the definition of occupational therapy in the state's practice act. In September 2005, Governor Mike Easley signed legislation to revise the practice act; however, language to update the definition was removed from the bill to address concerns raised by physical therapists (PTs) and chiropractors. The North Carolina legislation will use AOTA's model definition of occupational therapy practice. AOTA members in North Carolina are urged to ask their state legislators to pass H.B. 287.
The New York State Occupational Therapy Association (NYSOTA) will continue to pursue legislation to amend the definition of occupational therapy, amend the state's referral requirements, clarify the licensed status and practice of occupational therapy assistants, require occupational therapy assistants to pass the National Board for Certification in Occupational Therapy exam to be licensed, authorize the licensure board to promulgate supervision regulations, and change the composition of the licensure board. AOTA will be working with NYSOTA to organize a grassroots letter writing and e-mail campaign from members to state legislators.
This year, state association members will again have to watch for initiatives to expand the PT scope of practice in their practice acts. State PT chapters are being encouraged to adopt The Model Practice Act for Physical Therapy, which echoes the broadened PT scope outlined in the American Physical Therapy Association's Guide to Physical Therapist Practice. Of particular concern is the addition of "functional training in self-care and in home, community or work reintegration" to the model definition of PT. The limited context in which PTs address functional training is not clearly defined, which may mislead consumers and encroach on the traditional domain of occupational therapy.
State association members should also expect additional scope of practice challenges from speech-language pathologists, athletic trainers, recreational therapists, orthotists and prosthetists, wheelchair suppliers and manufacturers, optometrists, and psychologists. In some cases, groups at the state level seek to prevent occupational therapists from providing certain types of evaluations or interventions. In other cases, state health professional associations or chapters are seeking to expand their scope of practice to provide services that have been within the traditional domain of occupational therapy.
Although many times these scope of practice challenges surface through changes to state practice acts, they may arise through changes in state payment policy. In 2004 the North Carolina legislature passed legislation to restrict Medicaid reimbursement for orthotics and prosthetics to "board certified" providers. The two-sentence provision was buried in a 203-page appropriations bill. The state's Division of Medical Assistance narrowly interpreted "board certified" to mean certified orthotists and prosthetists—and not occupational therapists. The impact on occupational therapy practitioners was not known until they started to receive denials. Limiting payment for services to certain professions has the same impact as restrictive language in a practice act. NCOTA will be working with state legislators and the Division of Medical Assistance to amend the policy to include occupational therapy practitioners.
Although the 2006 legislative sessions will be challenging for the profession, your membership in AOTA and state associations provides us with the resources to engage on these issues on your behalf.
Charles Willmarth is Director, State Affairs, in AOTA's State Affairs Group.
Reference Information:
Willmarth, C. (2005). State legislative forecast. [Electronic Version]. OT Practice, 11(2), 6.
©Copyright 2006. The American Occupational Therapy Association. All rights reserved.